Moderator EMEDPA Posted August 11, 2020 Moderator Share Posted August 11, 2020 16 yr old male brought in by ems in c-spine precautions after what is reported as a moderate t-bone mva. patient was front seat passenger and struck that side. was restrained and ambulatory at scene. on cell phone when I walk in room. ok trauma, alert...whatever.... exam: minimal tachy, like 105. ok that buys you 2 IVs, labs and cxr. sao2 95%. nad R chest wall with minimal lateral /posterior ttp without ecchymosis, deformity, crepitus, or inflam. U/S FAST NL. remainder of trauma exam nl. collar/backboard removed. Given IV fluids, zofran for nausea, and fentanyl for pain. CXR no PTX, hazy right chest findings suspicious for pulmonary contusion. labs trauma labs nl aside from ast/alt both in 600 range....ok, mechanism plus pulmonary contusion, plus elevated transaminases gets you CT chest/abd/pelvis with contrast..... drum roll please: multiple posterior rib fxs on 9-11 on R. Contained/subcapsular liver hematoma, sacral fx.....mind you pt still on cell phine in minimal distress.....transferred to regional peds trauma receiving facility.... go with your gut folks and follow the algorithm....it would have been easy to send this pt home with minimal workup....I later saw pix of the car. NOT a minor MVA. significant passenger space intrusion on R front passenger side....which tells me something about the crappy ems report, but that is a story for another time... 3 Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted August 11, 2020 Share Posted August 11, 2020 Good catch. In this day of cell phone cameras why didn't EMS show you pics of the cars? I even remember when we took Polaroids to show hospital staff. Guess I'm spoiled by the EMS crews where I work. 1 Quote Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted August 11, 2020 Share Posted August 11, 2020 (edited) Great example of why information needs to be given on amount of compartment compromise. Another pet peeve? Tourniquets without noting time of placement, especially if rural. With all the scan capability now we're also realizing that some internal decapitations are surviving to hospital arrival/assessment. Edited August 11, 2020 by GetMeOuttaThisMess 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 11, 2020 Author Moderator Share Posted August 11, 2020 5 hours ago, ohiovolffemtp said: Good catch. In this day of cell phone cameras why didn't EMS show you pics of the cars? I even remember when we took Polaroids to show hospital staff. Guess I'm spoiled by the EMS crews where I work. one of the parents later showed me pix...after the dx was made... Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 11, 2020 Author Moderator Share Posted August 11, 2020 4 hours ago, GetMeOuttaThisMess said: Great example of why information needs to be given on amount of compartment compromise. Another pet peeve? Tourniquets without noting time of placement, especially if rural. With all the scan capability now we're also realizing that some internal decapitations are surviving to hospital arrival/assessment. TK needs to be written on forehead with time! Quote Link to comment Share on other sites More sharing options...
MediMike Posted August 11, 2020 Share Posted August 11, 2020 7 hours ago, ohiovolffemtp said: Good catch. In this day of cell phone cameras why didn't EMS show you pics of the cars? I even remember when we took Polaroids to show hospital staff. Guess I'm spoiled by the EMS crews where I work. Same page, although if you don't have an agency issued phone there can be some issues with taking photos in your personal cell (supposedly). At least that's what we were always told. Picture tells a thousand words etc etc 1 Quote Link to comment Share on other sites More sharing options...
DogLovingPA Posted August 15, 2020 Share Posted August 15, 2020 Nice catch. That would of been an easy miss. 1 Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You can post now and register later. If you have an account, sign in now to post with your account.